ตารางที่4 Summary of specific antidote treatment for organophosphate poisoning
|
Level of poisoning |
Clinical feture |
Red cell cholinesterase (%normal) |
Treatment |
|
Subclinical |
No symptoms or signs |
>50% |
Observation only |
|
Mild |
Tiredness, dizziness, headache,
nausea, vomiting,diarrhea, abdominal
pain, salivation, wheezing |
20-50% |
Atropine 1 mg IV or IM (test dose)(child: 0.01 mg/kg)
Pralidoxime 1 g IV or 7.5-10 mg/kg IM
-
(child: 25 mg/kg over 15-30 min)
|
|
Moderate |
Symptoms of mild poisoning
plus weakness, inability to walk,
muscle fasciculations,
dysarthria, miosis |
10-20% |
Atropine 2 mg IV or IM every 10-15 min
-
(child: 0.02-0.05 mg/kg)
Pralidoxime1-2 g IV (max rate 0.5 g/min, or over 15-30 min)
-
or 7.5-10 mg/kg IM (child: 25-50 mg/kg over 15-30 min)
-
repeatable after 1 hr., then 8-12 hourly
|
|
Severe |
Symptoms of moderate poisoning
plus coma, flaccid paralysis,
cyanosis, pulmonary edema and
respiratory distress, marked miosis
with loss of pupil reflexs |
<10% |
Atropine 4-5 mg IV or IM every 10-15 min,
-
then 0.08 mg/kg/hr if needed
-
(child 0.02-0.05 mg/kg, repeated)
Pralidoxime1-2 g IV (max 0.5 g/min, or over 15-30 min),
-
repeated after 1 hr, then 8.12 hourly (or 7.5-10 mg/kg IM,
-
repeated, or up to 0.5 g/hr by IV infusion)
-
(child: 25-50mg/kg IV over 15-30 min)
|
|
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